5 RISK IN PREGNANCY Definition of Outcome MeasuresPerinatal mortality rateall stillbirths (intrauterine deaths) > 500 grams plus all neonatal deaths per 1,000 total birthsNeonatal deathdeath of a live-born infant less than7 days after birth (early) or less than 28 days (late)Live birthan infant weighing 500 grams or more exhibiting any sign of life after full expulsion, whether or not the cord has been cut and whether or not the placenta is still in placeI9NSER MM

15 Which of the following statements best describes the foramen ovale:It shunts blood from right to leftIt connects the pulmonary artery with the aortaIt shunts deoxygenated blood into the left atriumIt is an extra cardiac shuntIt is functional after birth

35 Risk Classification System for Drug Use in PregnancyCategoryDescriptionATaken by a large number of pregnant women. No increase in malformation.BTaken by only a limited number of pregnant women and women of childbearing age. No increase in malformation.Studies in animals wither show no increase or are inadequate.CHave caused or may be suspected of causing harmful effects on the human foetus or neonate without causing malformations. These effects may be reversible.DHave caused an increased incidence of human foetal malformations or irreversible damage.XDrugs that have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy.

51 The perinatal mortality rate is defined as:The number of neonatal deaths that occur per 1000 live birthsThe number of stillbirths that occur per 1000 birthsThe number of fetal deaths within the first week after birthThe number of stillbirths and neonatal deaths in the first week of life per 1000 live birthsd

66 Characteristics or associated findings with late decelerations include all of the following except:They may be seen in patients with pre-eclampsiaThey may be associated with respiratory alkalosisThey are associated with a decreased uteroplacental blood flowThey often are accompanied by decreased PO2They usually are accompanied by an increased PCO2

89 A complete breech presentation is best described by which of the followingstatements:The legs and thighs of the fetus are flexed.The legs are extended and the thighs are flexed.The arms, legs, and thighs are completely flexed.The legs and thighs are extended.None of the above

120 Polyhydramnios Definition:An excess of liquor to such a degree that it is likely to influence the course or management of pregnancy.>20 cmDiagnosis:SFH increased: large for datesTense and uncomfortableFluid thrillDifficult to feel fetus

122 DystociaDefinition:Abnormal progression of labour in the ACTIVE PhaseCervical dilatation of <0.5 cm/hr over a 4 hr periodarrest of progress in the ACTIVE phase either in the first or second stage of labourFailure of descent of presenting partFriedman’s curve

127 Initial measure to treat dystociaA. Attention to:ComfortwellbeinghydrationB. AmniotomyC. Oxytocin if A+B failD. Wait long enough to see a response

128 Oxytocin usage Dosage: Depends on your hospital protocolInitial dose: 1 to 2 mu/minRate increased by 1 to 2 mu/min every 30 min until contractions are considered adequateand cervical dilatation achievedClinical response usually seen at dose levels of 8-10 mu/min

129 Reduction of risk of dystociaAvoid induction for large fetal weightAvoid oxytocin use with unfavourable cervixAvoid admission to Labour and Delivery at <4cm dilatation“Management” of epidural at full dilatationAvoid immediate pushing after full dilatation

131 Supportive strategiesCervical evaluation for ripening prior to booking inductionObstetrical triageContinuous professional support in active labourMobilization of women in active labourMinimization of motor blockage with epiduralUse of amniotomy and oxytocin prior to C/S for dystocia